Impact of Bifurcation Angle on Side Branch Occlusion in Provisional Bifurcation Stenting

Background: Bifurcation angle (BA) is the critical angle that has impact on side branch (SB) occlusion during coronary intervention due to plaque shift. There have been few research studies especially in Pakistan on the role of BA in plaque shift. Objective: To know the impact of bifurcation angle on the side branch occlusion during provisional stenting. Methodology: A retrospective cohort study was conducted at Punjab Institute of Cardiology, Lahore on consecutively enrolled patients between July 2017 and June 2019. The subjects were split into two groups: high angle and low angle using the median BA. Binary logistic regression analysis was performed to identify BA as an independent predictor of occlusion of SB. Results: Occurrence of side branch occlusion was found in 7.7% of the total of 600 bifurcation lesions. SB occlusion rate was found to be significantly higher in higher angle (HA) group compared to lower angle (LA) group i.e. (37/292, 12.7 %) and (9/308, 2.9 %) respectively, (P < 0.001). Binary logistic regression analysis demonstrated high angle to be an independent predictor for the occlusion of side branches (odds ratio [OR]: 1.026 per degree increment, 95% confidence intervals [CI]: 1.016 - 1.045, P < 0.001). Conclusion: Higher branching angle was noted as the independent predictor of the occlusion of side branches following provisional stenting of main vessel.